Provider Demographics
NPI:1083183487
Name:BELL, ELIJAH (PH D)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-0352
Mailing Address - Country:US
Mailing Address - Phone:718-378-3540
Mailing Address - Fax:
Practice Address - Street 1:1591 BRUCKNER BLVD APT 14D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6431
Practice Address - Country:US
Practice Address - Phone:718-378-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022996-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral